Pediatric Dental Coverage

Pediatric dental coverage, both on and off the marketplace has been one of our frequently asked questions, and is offering some continued discussion on this topic.  
    
On the Marketplace:
In the Health Insurance Marketplace, you can obtain dental coverage two ways: as part of a health plan, or by itself through a separate, stand-alone dental plan. You can purchase a dental plan through the federal Marketplace only when you enroll in a health plan.  The states that run their own Marketplaces allow you to buy a dental plan without also buying a health plan.

You can see plans and prices for stand-alone dental plans available in your area by clicking on this link: https://www.healthcare.gov/find-premium-estimates/

Under the Affordable Care Act (ACA), dental insurance is handled differently for adults and children 18 and under. Dental coverage for children is an essential health benefit. For example, if you are getting coverage for someone 18 or younger, dental coverage must be available as part of a health plan or as a stand-alone plan. While it must be available to you, you do not have to buy it.

This is not the case for adults. Insurers don’t have to offer adult dental coverage.  Under the health care law, most people must have health coverage or pay a penalty. But this isn’t true for dental coverage. You don’t need to have dental coverage, even for children, to avoid the penalty.

Off the Marketplace:
Starting in 2014, the ACA required that individual and small-group health plans sold both on the state-based health insurance exchanges and outside them on the private market cover pediatric dental services. According to the Centers for Disease Control and Prevention, tooth decay is the most common chronic health problem in children. By the time they enter kindergarten, more than a quarter of kids have decay in their baby teeth. The problem worsens with age, and nearly 68 percent of people age 16 to 19 have decay in their permanent teeth.  

Pediatric dental care was included as one of the ten essential health benefits required by the new healthcare law, both on and off the marketplace. This means, an individual or employee in a small-group private health plan will have pediatric dental coverage available.  Those without dependents would not use the pediatric care, thus have no cost.

As always, please feel free to contact our government relations team with any questions or comments by email: bbochniak@michbusiness.org or by phone: 888-277-6464 ext 401.